<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603596
Report Date: 02/25/2025
Date Signed: 02/25/2025 10:22:24 PM

Document Has Been Signed on 02/25/2025 10:22 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:PEOPLE'S CARE JOHNSON LAKEFACILITY NUMBER:
374603596
ADMINISTRATOR/
DIRECTOR:		SILVIA DAVALOSFACILITY TYPE:
735
ADDRESS:11691 JOHNSON LAKE DRTELEPHONE:
(619) 390-1380
CITY:LAKESIDESTATE: CAZIP CODE:
92040
CAPACITY: 4CENSUS: 4DATE:
02/25/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:House Lead Verenice GalindoTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Debbie Correia visited the facility to conduct an annual required licensing inspection. LPA Correia was met by House Manager, and Direct Support Service Provider (DSP) Verenice Galindo, identified herself, was granted entry into the facility, and explained the purpose of the visit. Administrator Davalos arrived a short time later and joined the annual inspection visit.

According to the facility’s license, the facility can serve four (4) ambulatory developmentally disabled adults. The facility currently houses four (4) clients that are all ambulatory. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Doors, windows and screens, sinks, and toilets were in working order. Hand hygiene supplies and Personal Protective Equipment were present. The facility had sufficient space and supplies to facilitate client activities.

Clients take medications are centrally stored in a locked cabinet, as well as sharp objects and toxic chemicals /poisons. There were no bodies of water on the premises. Per Administrator Davalos, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. The fire extinguisher was serviced within the last 12 months. A first aid kit was present and complete and readily accessible. A review of staff and client records were accurate and complete. In addition, a review of client P&I funds transactions were accurately recorded.


[Continued on LIC809C]
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE: DATE: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/25/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: PEOPLE'S CARE JOHNSON LAKE
FACILITY NUMBER: 374603596
VISIT DATE: 02/25/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
[Continuation of LIC 809]

Cleaning supplies and other toxins were inaccessible to clients in care. There were no bodies of water on the facility property. The facility had ample space for activities and a large outdoor shaded area. The facility’s ambient internal temperature was compliant, at 73-degrees Fahrenheit. The facility's hot water temperature for faucets used by clients measured at 117-degrees Fahrenheit.

Based on today’s inspection, there are no deficiencies being cited. An exit interview was conducted and a copy of this report, and Licensee Rights - LIC 9058 (rev. 01/16) will be provided to Administrator Davalos to whose signature below confirms receipt of the reports.

SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2025
LIC809 (FAS) - (06/04)
Page: 2 of 2